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Recent studies reported that vascular cognitive impairment in the elderly caused by arteriosclerosis plays an important role in cognitive disorders in both vascular dementia and Alzheimer's disease. In addition, systemic metabolic disorders such as oxygen metabolism dysfunction could be risk of dementia. Based on these findings, we have developed a deep neural network-based screening test (DNN-based test) of cognitive function using basic blood test data, which allowed prediction of cognitive function expressed by Mini Mental State Examination (MMSE) scores.Here, we investigated whether the DNN-based test could be applicable to assessment of the effects of exercise-diet on cognitive function.We studied the following two groups: (1) seven subjects of the local fitness gym (68.6 ± 3.2 years old). We evaluated cognitive function by the DNN-based test using blood data before and after the intervention (for 3 months). These results were compared with the measured MMSE score. (2) we studied a total of 230 subjects (67.9 ± 7.4 years old) who were members of the Tsuminory health class (Apple classroom). We assessed cognitive function by the DNN-based test before and after the intervention (for 2 months). We compared the predicted MMSE scores by the DNN-based test before and after the 2-month intervention.In the first group, the MMSE score predicted by the DNN-based test increased from 27.1 ± 0.8 to 27.6 ± 0.7 after the intervention period (p = 0.024). The measured MMSE score also increased after exercise, but not significant (P = 0.28). In the second group, the exercise-diet therapy increased the predicted MMSE scores in 189 cases (p 0.001). In contrast, the therapy significantly reduced the mean MMSE score (p 0.001).The MMSE score predicted by the DNN-based test were increased by exercise-diet therapy in most subjects. The DNN-based test may be useful to monitor the effect of exercise-diet therapy on cognitive function aged people.

Introduction The electrical pulmonary vein (PV) isolation has been established as a curative therapy for paroxysmal atrial fibrillation (AF). Arctic Front™cryoballoon has been used worldwide for AF cryoablation. Recently, a new cryoballoon, POLARxTM CRYOABLATION system have been introduced, of which material of the balloon is softer and the N2O gas flow rate is higher. Purpose The aim was to investigate the procedural parameter and efficacy of POLARx comparing with Arctic Front. Methods This retrospective single center study included 101 consecutive patients who underwent paroxysmal AF ablation using cryoballoon at Keio University hospital from April 2021 to March 2022. The procedural data including the cryoballoon temperature and the number and duration of cryoablation were compared between POLARx (POLARx group) and ARCTIC FRONT ADVANCE PRO (AFA group). After the cryoablation, we added the radiofrequency application in order to maximize the isolated area when the voltage was remained inside PV (Figure 1). The necessities of the additional radiofrequency applications were also compared. Results In the present study, 64 patients in AFA group and 37 patients in POLARx group were analyzed. POLARx group included younger population and less females (62.8±9.9 vs 67.5±9.4 year of age, P=0.02; 13.5 vs 32.8%, P=0.04). There was no significant difference in comorbidities and examination data such as left atrium diameter or brain natriuretic peptide level. The minimal cryoballoon temperatures reached in POLARx group were lower than AFA group (−59.3±6.2 vs −47.7±7.5°C, P Conclusion The total number and duration of cryoablation were not significantly different between AFA and POLARx group, except for right superior PV. There was an advantage in largely isolating right inferior PV in POLARx group comparing with AFA group. Funding Acknowledgement Type of funding sources: None.

Background Radiomics is a comprehensive analysis methodology of medical image and involves the extraction of numerous features from standard imaging. Its usefulness has been reported mainly in the field of cancer for diagnosis and prediction of prognosis. In the territory of cardiac imaging, several reports have investigated the utility of radiomics for classifying the risk of prognosis in coronary artery disease, and few practical applications have been reported for patients with atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI). Although the left atrial morphology can affect the clinical course after the PVI procedure, it is unclear whether the radiomics feature values of the left atrial morphology on cardiac computed tomography (CT) is useful for predicting the AF recurrence after PVI. Purpose To predict the recurrence of AF after PVI using the radiomics feature values of the left atrial morphology on cardiac computed tomography (CT). Methods We analyzed 525 consecutive three-dimensional cardiac CT in patients with atrial fibrillation who underwent PVI from 2018 to 2019 in our institute. After marking the region of interest on left atrium (including the root of pulmonary veins) semiautomatically, 107 radiomics feature values were obtained by Python program. After excluding the parameters having collinearity or with low predictive capability for the recurrence of AF after PVI, 42 parameters were applied to the final prediction model. Two prediction models were constructed by multivariate Cox regression analysis and machine learning model by support vector machine algorithm. Results The area under the curve (AUC) for predicting the recurrence of AF was 0.815 for the multivariate Cox regression model and 0.826 for the machine learning model by support vector machine. Conclusion The radiomics feature values on preprocedural cardiac CT could be helpful for predicting the recurrence of AF after PVI. Since radiomics feature analysis yields a huge number of numerical values representing the left atrial morphology in a reproducible manner, it would provide a new direction to construct a good prediction model using machine learning including artificial intelligence out of a routine cardiac CT scan. Funding Acknowledgement Type of funding sources: None.

Background Patients with Low-flow low-gradient (LFLG) aortic valve stenosis (AS) have possibly poor prognosis. Recently, it was reported that the LFLG AS patients have similar outcomes compared to high-gradient (HG) patients but worse outcomes compared to the normal-flow low-gradient [NFLG: SVi≥35 ml/m2, mPG Purpose We elucidated about the prognosis of LFLG AS with AF. Methods We included 225 consecutive patients with severe AS (SAS, iAVA Results Among patients with HG SAS and LFLG AS, worsening HF was observed in 65 patients. LFLG AS patients exhibited a higher oral rate of renin-angiotensin-system inhibitors (p=0.02). In addition, SVi and E/e' was lower in LFLG AS patients compared with HG SAS [SVi; 29.4 (24.4–34.0) versus 37.7 (28.2–45.3), p Conclusion LFLG AS with AF exhibited a poor prognosis for HF compared with HG SAS without AF and equivalent rate of worsening HF compared with HG SAS with AF. Furthermore, the presence of pAf was associated with an increased risk of HF in patients with LFLF AS. Thus, intervention including drugs and catheter ablation for pAF in LFLG AS patients could lead to prevent worsening clinical outcomes. Funding Acknowledgement Type of funding sources: None.

Background Atrial fibrillation (AF) is a risk factor for ischemic stroke (IS). We developed a novel risk score of IS (HELT-E2S2 score) in non-valvular atrial fibrillation (NVAF) patients from the combined database of 5 major AF registries in Japan. However, this score does not include echocardiographic (Echo) parameters that have been reported to be risk factors of IS, such as left atrial diameter (LAD) enlargement or increased relative wall thickness (RWT) of left ventricle (LV). Purpose To investigate the predictive value of Echo parameters in Japanese patients with NVAF. Methods After excluding patients without the Echo data, 6,032 NVAF patients were analyzed in the present study. LAD was measured in the parasternal long axis view at the end-ventricular systole. RWT was calculated as (2x posterior wall thickness)/ LV end-diastolic dimension. We compared clinical characteristics and the incidence of IS between NVAF patients divided by LAD level (High/Low LAD group) and RWT level (High/Low RWT group). To balance the follow-up period among the registries, event data from individuals whose follow-up period exceeded 730 days were excluded from the analysis. Results The optimal cut-off value of LAD and RWT to predict the incidence of IS with the receiver operating characteristic analysis was 43.3 mm and 0.4167, respectively. Between the High/Low LAD groups (High LAD: n=2,640 vs. Low LAD: n=3,392), age (70.3±12.1 vs. 68.3±12.5 years; p Conclusion Echo parameters, LAD and RWT, were independently associated with the incidence of IS among Japanese patients with NVAF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development

Background Atrial fibrillation (AF) patients with a history of ischaemic stroke (IS) have a higher risk for recurrent IS events and were largely excluded from the pivotal, randomised, controlled phase 3 trials on oral anticoagulants. Thus, the effectiveness and safety of edoxaban in these patients need to be studied in a real-world setting. Purpose To compare edoxaban real-world effectiveness and safety in AF patients with or without an IS history. Methods The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients receiving edoxaban for stroke prevention. This snapshot analysis summarises baseline characteristics with medical history and 2-year annualised rates of all-cause death, cardiovascular (CV) death, stroke (haemorrhagic, ischaemic, any), and bleeding (including major bleeding [MB], major gastrointestinal [GI] bleeding, intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding [CRNMB], and any bleeding) in patients with or without IS history. Results Data from 27,333 patients (3215 with prior IS and 24,118 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with IS history were significantly older, more likely ≥75 years of age, and had a lower mean body weight and creatinine clearance (P Conclusions Patients with AF who have a history of IS are more likely elderly; have histories of MB, ICH, and TIA; and have high baseline stroke and bleeding risk scores. Patients with IS history receiving edoxaban have a considerably higher likelihood of experiencing IS or TIA, whereas the risk of experiencing any bleeding event (with the exception of ICH) is only modestly higher than in those without IS history. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo

Background Radiomics is a comprehensive analysis methodology of medical image and involves the extraction of numerous features from standard imaging. Its usefulness has been reported mainly in the field of cancer for diagnosis and prediction of prognosis. In the territory of cardiac imaging, several reports have investigated the utility of radiomics for classifying the risk of prognosis in coronary artery disease, and few practical applications have been reported for patients with atrial fibrillation (AF) who underwent catheter ablation (CA). Purpose The objective of this study was to evaluate the utility of radiomics analysis applying to the preprocedural cardiac computerized tomography (CT) in AF patients. Methods We analyzed 525 consecutive three-dimensional CT in patients with AF who underwent CA. After marking the region of interest on left atrium (LA) (including the root of pulmonary veins) semiautomatically, 107 radiomics feature values were obtained by Python program. We calculated the amount of representative statistics for each radiomics feature for prediction of persistent AF (PeAF) (Wald statistic in logistic regression analysis) and LA diameter (LAD) (coefficient correlation), respectively. To compare the distribution of the two statistics, the relative importance (calculated as the ratio of statistic to the maximum statistics among 107 radiomics features [%]) was calculated for each statistic. Further, we compared the area under the curve (AUC) in receiver operation characteristic (ROC) curve analysis for predicting PeAF between radiomics features (multivariate model) and LAD (single parameter). Results In 525 study patients (age 63±10 years old and male 80%), 253 (48%) were PeAF and remaining were paroxysmal AF (PAF). LAD was 43±6 mm and 38±6 mm in patients with PeAF and PAF, respectively. The relative importance of the two statistics (Wald statistic for PeAF and coefficient correlation for LAD) of 107 radiomics features are displayed in Figure 1, which shows similar distribution of two statistics. It means the close relationship between LA morphology and the form of PeAF in AF patients and the radiomics features possibly well explain the relationship. In Figure 2, the predictive capability for PeAF was compared between radiomics feature values and LAD, where the AUC was 0.85 (95% confidence interval [CI], 0.82–0.88) and 0.73 (95% CI, 0.69–0.78) for radiomics feature values and LAD, respectively (Delong test, P Conclusion We applied the radiomics features for the evaluation of LA morphology. The predictive capability for PeAF in the prediction model with the radiomics feature values was much better than that with LAD alone. Since radiomics feature analysis yields a huge number of numerical values representing the LA morphology in a reproducible manner, it would provide a new direction to construct a good prediction model using machine learning including artificial intelligence out of a routine cardiac CT scan. Funding Acknowledgement Type of funding sources: None.

Background and purpose The All Nippon AF In the Elderly (ANAFIE) registry evaluated the current status of anticoagulant therapy in older adult patients (aged ≥75 years) with non-valvular atrial fibrillation (NVAF) in Japan. Although older adult NVAF patients requires anticoagulation therapy, some of them do not receive it and the reasons would be diverse. Therefore, we aimed to identify the phenotypes of older adult NVAF patients not treated with oral anticoagulants using data from the ANAFIE registry. Methods In this sub-analysis of the ANAFIE registry, the phenotypes of patients who were not receiving anticoagulants at baseline were evaluated by cluster analysis using Ward's linkage hierarchical algorithm. We used 20 categorical variables and 6 continuous variables for the cluster analysis which were used as the risk factors in the main analysis of the ANAFIE registry [1]. Results Of 33,275 enrolled patients, 2445 (7.3%) were not receiving anticoagulants. Two clusters were identified: (1) elderly paroxysmal AF (PAF) patients with a low prevalence of comorbidities (58%) and (2) very elderly patients with a high previous major bleeding prevalence (42%). For each cluster, mean ages were 79.9 and 85.7 years, mean CHADS2 scores were 2.3 and 3.1, PAF prevalences were 83% and 54%, heart failure prevalences were 18% and 48%, the proportions of patients with a history of major bleeding were 0% and 25%, the proportions of patients with a history of catheter ablation were 21% and 8%, respectively. Annual incidence rates of each cluster were 2.62% and 9.08% for all-cause death, 1.72% and 5.83% for major adverse cardiovascular or neurological events, 1.22% and 3.14% for stroke or systemic embolism, and 0.53% and 1.43% for major bleeding. Conclusions In this cohort of elderly NVAF patients not receiving anticoagulants, more than half (∼60%) were PAF patients and had a low incidence of adverse outcomes. The remaining ∼40% were characterized as very elderly patients with a high prevalence of previous major bleeding and a high incidence of adverse outcomes. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Co., Ltd.

Background Atrial fibrillation patients with a history of major bleeding (MB) are at high risk of future bleeding events; this history was an exclusion criterion in pivotal phase 3 trials of anticoagulation for stroke prevention. Real-world edoxaban effectiveness and safety in patients with a history of MB were analysed from the global ETNA programme. Purpose To compare edoxaban effectiveness and safety in AF patients with or without an MB history. Methods The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients treated with edoxaban for stroke prevention. This snapshot analysis summarises global baseline characteristics and 2-year annualised rates of all-cause death, cardiovascular death, stroke (haemorrhagic, ischaemic, any), and bleeding (including MB, major gastrointestinal bleeding [MGIB], intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding, and any bleeding) in patients with or without MB history. Results Data from 27,333 patients (479 with MB history and 26,854 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with MB history were significantly older (P Conclusions Patients with AF receiving edoxaban and who have a history of MB are more likely elderly, male, and have comorbidities, including HF. These patients are also more susceptible to any adverse cardiovascular event. ICH event rates were not higher in patients with prior ICH than those with non-ICH major bleedings, whereas history of MGIB was associated with a high risk of MGIB recurrence. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo

In both 5- and 15-min data, FI was significantly higher in malignant tissues than in benign tissues. The diagnostic accuracy was similar at 5 and 15 min. Therefore, the 5-min FI was enough applying in the further analyses.

Made available in DSpace on 2022-04-29T08:37:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) We revisited how Weinberg’s ideas in Nuclear Physics influenced our own work and lead to a renormalization group invariant framework within the quantum mechanical few-body problem, and we also update the discussion on the relevant scales in the limit of short-range interactions. In this context, it is revised the formulation of the subtracted scattering equations and fixed-point Hamiltonians applied to few-body systems, in which the original interaction contains point-like singularities, such as Dirac-delta and/or its derivatives. The approach is being illustrated by considering two-nucleons described by singular interactions. This revision also includes an extension of the renormalization formalism to three-body systems, which is followed by an updated discussion on the applications to four particles. Instituto de Física Teórica Universidade Estadual Paulista Instituto Tecnológico de Aeronáutica DCTA Grupo de Optica e Modelagem Numérica Faculdade de Tecnologia GOMNI/FT - Universidade Estadual de Campinas UNICAMP Instituto de Física Teórica Universidade Estadual Paulista FAPESP: 2017/0566-0 FAPESP: 2019/00153-8 FAPESP: 2019/10889-1 CNPq: 303579/2019-6 CNPq: 304469/2019-0 CNPq: 30486/2015-3 CNPq: 306615/2018-5 CNPq: 464898/2014-5

We solved analytically the three-body mass-imbalanced problem embedded in D dimensions for zero-range resonantly interacting particles. We derived the negative energy eigenstates of the three-body Schrodinger equation by imposing the Bethe-Peierls boundary conditions in D-dimensions for zero-energy two-body bound states. The solution retrieves the Efimov-like discrete scaling factor dependence with dimension. The analytical form of the mass-imbalanced three-body bound state wave function can be used to probe the effective dimension of asymmetric cold atomic traps for Feshbach resonances tuned close to the Efimov limit.

Background Leucine-rich alpha 2 glycoprotein (LRG) reflects mucosal healing in ulcerative colitis (UC) and is useful for assessing mucosal healing. In this study, we hypothesized that endoscopy for activity evaluation may be unnecessary depending on LRG levels, and investigated the relationship between LRG and endoscopic findings. Methods Patients who underwent endoscopy for UC from April 2021 to August 2022, when LRG measurement became available, and whose LRG was measured within a month, were included in the study. The relationship between Mayo endoscopic subscore (MES) and LRG was evaluated and symptoms were also reviewed to examine these relationships. Endoscopic remission was defined as MES 1 or less. Results The mean (range) LRG values per MES and the percentage of patients with a cutoff value of less than 16 μg/mL were MES 0 (n=86): 11.3±2.8 (6.0-24.2) μg/mL, 96.5%; MES 1 (n=56): 13.3±6.0 (7.7-43.8) μg/mL, 79.2%; MES 2(n=53): 21.7±11.5(8.1~65.1) μg/mL, 34.0%, MES 3(n=19): 26.4±9.3(12.3~42.9) μg/mL, 25.0%, and AUC 0.856 in ROC analysis, higher than other markers (CRP, Alb, WBC) LRG Even below the cutoff value, 15.0% (22/147) were in endoscopic non-remission. Even when patients have neither diarrhea 3 or more times a day nor bloody stool, 7.4% (9/122) were still in endoscopic non-remission. However, there were no cases in endoscopic non-remission when the LRG was below the cutoff value and there were no such symptoms. In multivariate analysis using binomial logistic regression analysis, LRG (p=0.028) was an independent predictor of endoscopic remission, in addition to diarrhea (p=0.003) and bloody stool (p Conclusion LRG was a useful tool for predicting endoscopic activity in ulcerative colitis, but LRG alone could not exclude non-remitting cases. However, LRG was considered to be an independent predictor of endoscopic remission, and all patients who had less than the LRG cutoff value and no diarrhea or bloody stool more than 3 times a day showed endoscopic remission, suggesting that endoscopy for activity evaluation may be unnecessary in such cases.

Muon catalyzed fusion ($\mu$CF) has recently regained considerable research interest owing to several new developments and applications. In this regard, we have performed a comprehensive study of the most important fusion reaction, namely $(dt\mu)_{J=v=0}\to\alpha$+$n$+$\mu$+17.6 MeV or $(\alpha \mu)_{nl}$+$n$+17.6 MeV. The coupled-channels Schr\"{o}dinger equation for the reaction is thus solved, satisfying the boundary condition for the muonic molecule $(dt\mu)_{\rm J=v=0}$ as the initial state and the outgoing $\alpha n \mu$ channel with the $\alpha$-$n$ $D$ wave. We employ the $dt\mu$- and $\alpha n \mu$-channel coupled three-body model. All the $d$-$t$ and $\alpha$-$n$ potentials, and the $d t$-$\alpha n$ channel-coupling nonlocal tensor potential are chosen to reproduce the observed low-energy astrophysical $S$-factor of the reaction $d$+$t\to\alpha$+$n$+17.6 MeV, as well as the total cross section of the $\alpha$+$n$ reaction. The resultant $dt\mu$ fusion rate is 1.15x10$^{12}$ s$^{-1}$. Substituting the obtained total wave function into the $T$ matrix, we have calculated absolute values of the fusion rates going to the bound and continuum states of the outgoing $\alpha$-$\mu$ pair. We then derived the initial $\alpha$-$\mu$ sticking probability $\omega_S^0$=0.857%, which is $\sim$7% smaller than the literature values ($\simeq$0.91-0.93%), and can explain the recent observations (2001) at high D-T densities. We also calculate the absolute values for the momentum and energy spectra of the emitted muon. The most important result is that the peak energy is 1.1 keV although the mean energy is 9.5 keV. This is an essential result for the ongoing experimental project to realize the generation of an ultra-slow negative muon beam by utilizing the $\mu$CF for various applications e.g., a scanning negative muon microscope and an injection source for the muon collider., Comment: 21 pages, 18 figures; Fig. 18 and Tables 1, 2 added; published in Phys. Rev. C 107, 034607 (2023)

Background The ESC atrial fibrillation management guidelines recommend a risk-based approach to oral anticoagulant (OAC) therapy. How clinical practice aligns with these recommendations is of interest. Purpose To analyse real world data from Global ETNA-AF program in patient groups stratified by stroke and bleeding risk scores according to ESC guidelines. Methods Global ETNA-AF is a multicentre, prospective, noninterventional program evaluating the safety and effectiveness of edoxaban in patients from European and Asian countries. Baseline characteristics and clinical event data at 2-year follow-up were analysed in 4 subgroups defined by CHA2DS2-VASc score (≥3 for female / ≥2 for male [OAC recommended] vs 2 for female / 1 for male [OAC should be considered]) and HAS-BLED score (≥3 [Bleeding risk high] vs Results Of 27,616 patients included in this analysis, 23,152 (83.8%) were in the “OAC recommended” category and 3,539 (12.8%) were in the “OAC should be considered” category. Only 3.3% of patients did not meet ESC guideline criteria for OAC initiation. Among patients with high bleeding risk, 98% were in the “OAC recommended” category. A similar distribution was observed across regions (Table 2). The recommended edoxaban dose was used in the vast majority (>80%) of patients across all risk stratification subgroups. In the “OAC recommended” category, patients with high bleeding risk had higher rates of thromboembolic, bleeding, and death events than those with low bleeding risk. Conclusion Data from routine clinical practice in Global ETNA-AF demonstrate high concordance of edoxaban treatment with ESC guidelines. Edoxaban dose is consistent with label recommendation in the vast majority (>80%) of patients. Clinical event rates were generally low across all risk groups, including acceptable bleeding rates in anticoagulated patients with high bleeding risk. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Table 1. Subgroups as per ESC guidelinesTable 2. Patient characteristics & events

The seizure resistance in the ironing process of stainless steel cups was improved with lubricants containing Al2O3 particles, and the ironing limit of the cups was increased. The effects of suspending different concentrations of Al2O3 particles in paraffin based oils on increasing the ironing limit of SUS430 cylindrical cups before seizure were investigated using a lapped tungsten carbide die. By containing c = 2vol% of Al2O3 particles having nominal diameter d between 0.02 to 4 micrometres in an oil with a kinematic viscosity of 500 mm2/s, the ironing limit of the cup was 8% under a punch speed of 100 mm2/s. The limit was similar to the limit using a commercial low-viscosity oil with chlorine additive. The kinematic viscosity of the base oil was reduced. In d = 0.2 μm and c = 0.5vol%, the limit of the oil more than kinematic viscosity of 180 mm2/s was similar to the limit by the commercial oil. In d = 4 μm and c = 1vol%, the limit of the oil having more than kinematic viscosity of 100 mm2/s was effective. It was found that the seizure resistance in the ironing process was improved by the proper ironing conditions with lubricants containing particles.

ResumoA síndrome do túnel do carpo (STC) é a neuropatia compressiva mais comum do corpo humano. Seus sintomas decorrem da compressão do nervo mediano no carpo. O tratamento pode ser incruento, com medicações e/ou infiltrações que amenizam os sintomas, ou cruento, mais eficaz, com a descompressão do nervo mediano pela seção cirúrgica do retináculo dos flexores do carpo. A técnica anestésica varia de acordo com o serviço de anestesia: sedação, anestesia locorregional venosa e, mais recentemente, a anestesia local com o paciente acordado e sem torniquete (wide-awake local anesthesia no tourniquet, WALANT), que pode ser realizada pelo próprio cirurgião. Por utilizar anestesia local com vasoconstritor, essa técnica dispensa o uso de torniquete no membro superior e a necessidade de sedação. O bloqueio do nervo mediano na WALANT guiada por ultrassonografia confere melhor precisão à técnica, e mais segurança ao paciente, e, neste artigo seu uso na realização da descompressão do túnel do carpo é descrito, e a literatura, revisada.

We previously reported, based on a multicenter randomized-control study, that the efficacy of intra-articular injections of hyaluronic acid (IA-HA) was not inferior to that of oral non-steroidal anti-inflammatory drugs (NSAIDs) in patients with knee osteoarthritis (OA). However, the molecular effects on the pathophysiology of knee OA remain unclear. C-terminal telopeptides of type II collagen (CTX-II) is reported to primarily originate from the interface between articular cartilage and subchondral bone, which is a site of potential remodeling in OA. We performed a predefined sub-analysis of the previous study to compare the changes of urinary CTX-II (uCTX-II) in response to IA-HA to those in response to NSAID for knee OA.A total of 200 knee OA patients were registered from 20 hospitals and randomized to receive IA-HA (2,700 kDa HA, 5 times at 1-week intervals) or NSAID (loxoprofen sodium, 180 mg/day) for 5 weeks. The uCTX-II levels were measured before and after treatment.The uCTX-II levels were significantly increased by IA-HA treatment (337.7 ± 193.8 to 370.7 ± 234.8 ng/μmol Cr) and were significantly reduced by NSAID treatment (423.2 ± 257.6 to 370.3 ± 250.9 ng/μmol Cr). The %changes of uCTX-II induced by IA-HA (11.6 ± 29.5%) and NSAID (-9.0 ± 26.7%) was significantly different (between-group difference: 20.6, 95% confidence intervals: 10.6 to 30.6).While both IA-HA and NSAID improved symptoms of knee OA, uCTX-II levels were increased by IA-HA and reduced by NSAIDs treatment, suggesting these treatments may improve symptoms of knee OA through different modes of action.

We present the results of surveying [CI] $^3P_1-^3P_0$, $^{12}$CO $J=4-3$, and 630 $\mu$m dust continuum emission for 36 nearby ultra/luminous infrared galaxies (U/LIRGs) using the Band 8 receiver mounted on the Atacama Compact Array (ACA) of the Atacama Large Millimeter/submillimeter Array. We describe the survey, observations, data reduction, and results; the main results are as follows. (i) We confirmed that [CI] $^3P_1-^3P_0$ has a linear relationship with both the $^{12}$CO $J=4-3$and 630 $\mu$m continuum. (ii) In NGC 6052 and NGC 7679, $^{12}$CO $J=4-3$ was detected but [CI] $^3P_1-^3P_0$ was not detected with a [CI] $^3P_1-^3P_0$/ $^{12}$CO $J=4-3$ ratio of $\lesssim0.08$. Two possible scenarios of weak [CI] $^3P_1-^3P_0$ emission are C$^0$-poor/CO-rich environments or an environment with an extremely large [CI] $^3P_1-^3P_0$ missing flux. (iii) There is no clear evidence showing that galaxy mergers, AGNs, and dust temperatures control the ratios of [CI] $^3P_1-^3P_0$/ $^{12}$CO $J=4-3$ and $L'_{\rm [CI](1-0)}/L_{\rm 630\mu m}$. (iv) We compare our nearby U/LIRGs with high-z galaxies, such as galaxies on the star formation main sequence (MS) at z$\sim1$ and submillimeter galaxies (SMGs) at $z=2-4$. We found that the mean value for the [CII] $^3P_1$--$^3P_0$/ $^{12}$CO $J=4-3$ ratio of U/LIRGs is similar to that of SMGs but smaller than that of galaxies on the MS., Comment: 11 pages, 7 figures, and 42 pages for the appendix, accepted for publication in ApJS

At the present, the grid-tied solar power system is the most promising as a renewable energy technology for replacing the fossil energy sources. The usage efficiency of the power conditioner system in the grid-tied solar power system is not high because the electricity generation from solar panels depends on the weather. The utilization rate of the power conditioner system can be increased by adding the small scale wind turbine to the existing grid-tied solar power system. We introduced a novel design solution in the previous study to connect the small wind turbine with the power conditioner system of the grid-tied solar power system by emulating technical characteristics of the solar panel in series connection mode. By which, the utilization rate of the power conditioner system has been increased. However, this improved utilization rate of the power conditioner system is not high in the cloudy and rainy days because the voltage of the solar panel changes slightly and the maximum input voltage of the power conditioner system is limited. Therefore, we propose a novel performance enhancement method for solar–wind hybrid power plant using photovoltaic cell emulating system in this research.

Background Blood pressure (BP) variability has reportedly been a risk factor for various clinical events. To clarify the influence of BP visit‐to‐visit variability on adverse events in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J‐RHYTHM Registry was performed. Methods and Results Of 7406 outpatients with nonvalvular atrial fibrillation from 158 institutions, 7226 (age, 69.7±9.9 years; men, 70.7%), in whom BP was measured 4 times or more (14.6±5.0 times) during the 2‐year follow‐up period or until occurrence of an event, constituted the study group. SD and coefficient of variation of BP values were calculated as BP variability. Thromboembolism, major hemorrhage, and all‐cause death occurred in 110 (1.5%), 121 (1.7%), and 168 (2.3%) patients, respectively. When patients were divided into quartiles of systolic BP‐SD (P =0.015 for thromboembolism; HR, 2.60, 95% CI, 1.36–4.97, P =0.004 for major hemorrhage; and HR, 1.85, 95% CI, 1.11–3.07, P =0.018 for all‐cause death) after adjusting for components of the CHA 2 DS 2 ‐VASc score, warfarin and antiplatelet use, atrial fibrillation type, BP measurement times, and others. These findings were consistent when BP‐coefficient of variation was used instead of BP‐SD. Conclusions Systolic BP visit‐to‐visit variability was significantly associated with all adverse events in patients with nonvalvular atrial fibrillation. Further studies are needed to clarify the causality between BP variability and adverse outcomes in patients with nonvalvular atrial fibrillation. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique Identifier: UMIN000001569.

Background In the phase III IMpassion130 trial, combining atezolizumab with first-line nanoparticle albumin-bound-paclitaxel for advanced triple-negative breast cancer (aTNBC) showed a statistically significant progression-free survival (PFS) benefit in the intention-to-treat (ITT) and programmed death-ligand 1 (PD-L1)-positive populations, and a clinically meaningful overall survival (OS) effect in PD-L1-positive aTNBC. The phase III KEYNOTE-355 trial adding pembrolizumab to chemotherapy for aTNBC showed similar PFS effects. IMpassion131 evaluated first-line atezolizumab–paclitaxel in aTNBC. Patients and methods Eligible patients [no prior systemic therapy or ≥12 months since (neo)adjuvant chemotherapy] were randomised 2:1 to atezolizumab 840 mg or placebo (days 1, 15), both with paclitaxel 90 mg/m2 (days 1, 8, 15), every 28 days until disease progression or unacceptable toxicity. Stratification factors were tumour PD-L1 status, prior taxane, liver metastases and geographical region. The primary endpoint was investigator-assessed PFS, tested hierarchically first in the PD-L1-positive [immune cell expression ≥1%, VENTANA PD-L1 (SP142) assay] population, and then in the ITT population. OS was a secondary endpoint. Results Of 651 randomised patients, 45% had PD-L1-positive aTNBC. At the primary PFS analysis, adding atezolizumab to paclitaxel did not improve investigator-assessed PFS in the PD-L1-positive population [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.60-1.12; P = 0.20; median PFS 6.0 months with atezolizumab–paclitaxel versus 5.7 months with placebo–paclitaxel]. In the PD-L1-positive population, atezolizumab–paclitaxel was associated with more favourable unconfirmed best overall response rate (63% versus 55% with placebo–paclitaxel) and median duration of response (7.2 versus 5.5 months, respectively). Final OS results showed no difference between arms (HR 1.11, 95% CI 0.76-1.64; median 22.1 months with atezolizumab–paclitaxel versus 28.3 months with placebo–paclitaxel in the PD-L1-positive population). Results in the ITT population were consistent with the PD-L1-positive population. The safety profile was consistent with known effects of each study drug. Conclusion Combining atezolizumab with paclitaxel did not improve PFS or OS versus paclitaxel alone. ClinicalTrials.gov NCT03125902.